Skeletal Trauma Flashcards by Thomas Etue

complete or incomplete disruption in continuity and structure of
the bone and/or cartilage.

Fracture

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bone is ______,
(unequal in strength) and can withstand
mechanical forces differently

anisotropic

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Cortical bone is stronger on

compression

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Cortical bone is less resilient to

distraction

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Cortical bone is most vulnerable to

shearing forces

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situations that increase risk of fracture?

repeated loading and the resulting fatigue
local/systemic pathology
surgical pin holes or bone resection

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Surgical pin holes or a site of bone resection may weaken the bone, known
as a?

stress raiser

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seen in children as 3-types

incomplete fracture

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3-types of incomplete fracture

Torus
Green stick
Plastic deformity

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cortical buckling on compression

Torus

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incomplete fracture on tension

Green stick

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bending of the bone without angular break and

remodeling

Plastic deformity

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transverse, oblique and spiral

Complete fracture

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fragment of bone being detached by the tension from

muscles or ligaments

Avulsion fracture

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typically corner fracture that is chipped rather than avulsed

Chip fracture

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results in telescoping of osseous

trabeculae

Impaction (compression)

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No typical radiolucent line is seen on radiographs and instead
a zone of sclerosis or condensation may be present describes what type of fracture?

Impaction (compression)

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typically in the calvaria (cranial vault) and

occasionally in Tibial plateau

Depression fracture

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repeated stress applied to normal bone –> marrow hyperemia and resorption

Stress (fatigue) fracture

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examples of Stress (fatigue) fracture

March fracture of 2nd

or 3d Metatarsal bone, Tibial stress fractures in runners etc

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normal stresses i.e. normal weight bearing, walking

applied to osteoporotic (involuted/insufficient) bone.

Insufficiency fracture

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vertebral

osteoporotic fracture is an example of an Insufficiency OR pathologic fracture?

Insufficiency fracture

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bone weakened by things such as neoplasms,

infection, congenital defect of collagen?

Pathologic fracture

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more than 2-segments

Comminution (comminuted) fracture

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2-subtypes of comminuted fracture

Segmental fracture and Butterfly fragment-

two separate fracture lines producing an isolated | segment of bone

Segmental fracture

wedge shaped fragment produced at the apex of the | maximum force

Butterfly fragment

Fx due to trabecular | telescoping and buckling

Torus fracture

deminiralised | bone is unable to adequately respond to normal mechanical stresses

insufficiency fracture

impaction/compression fracture of the anterior humeral head due to posterior shoulder dislocation and compression by the posterior glenoid rim, so-called...

“trough sign” | during posterior GHJ dislocation

Depressed fracture most seen in what bones?

flat

skin intact and no exposure to outside aire = Closed fracture

Closed fracture

Position of fractures based on?

regions of the bone (metaphysis vs | diaphysis

Intra-articular fracture extension can lead to what type of complications?

- delayed/abnormal healing - chondrolysis - secondary osteoarthritis

bone ends are not aligned is loss of?

apposition

overlap of one fragment over another

Bayonet apposition

complete loss of apposition

Distraction

classification of pediatric growth plate injury

Salter-Harris classification

classification of pediatric growth plate injury

Salter-Harris classification

most vulnerable regions in the pediatric | skeleton

epiphyseal growth | plate and growth apophysis

Why are the epiphyseal growth | plate and growth apophysis most vulnerable?

from the cartilagenous nature and metabolic activity

fracture through growth plate itself often unrecognized | because of minimal displacement

Salter-Harris 1

most common (>75%), fracture through physis and a part of metaphysis forming a Thurston-Holland fragment. Good healing prospects.

Salter-Harris 2-

through the plate and into epiphysis

Salter-Harris 3

fracture traverses metaphysis, physis and into epiphysis

Salter-Harris 4

crush injury to growth plate, often unrecognized or | confused with type 1 but essentially damages physeal blood supply.

Salter-Harris 5

which Slater-harris types are rare but show highest complications?

4 & 5

Salter-Harris type 4 and 5 can lead to...

premature | plate closure, limb deformities, shortening and other sequela

subtype of insufficiency fracture that develops | in bones with insufficient osteoid

Pseudo-fracture

Fracture most seen in Rickets & Osteomalacia

Pseudo-fracture

which type of fracture show very characteristic appearance on x-rays as widened transverse radiolucent lines oriented at the right angle typically to the medial cortex?

Pseudo-fracture

Pseudo-fractues are also referred to as...

- Looser zones - Milkman lines - umbau zones

Typically found along the medial aspect of the cortex of long bones

Pseudo-fractues

intra-osseous edema

bone bruise

not detected by conventional radiographs and best | seen on MR imaging

bone bruise

when injury and intra-osseous edema have occurred (Osteoclasts will become activated)

Occult fractures

Best example of an occult fracture is Injuries to

carpal navicular or | scaphoid bone

Occur in bones due to a mismatch of bone strength and chronic mechanical stress

stress fracture

complete loss of articular contact/alignment with resultant injury to periarticular restraints

Dislocation

partial loss of articular alignment

Subluxation

separation of fibrous joints or fibrocartilagenous joints often seen as suture diastasis in the scull and symphysis pubis

Diastasis

Develops prior closure | of skull sutures (<3 y.o) as a result of tear in the dura

Growing skull fracture or leptomeningeal cyst (not true cyst)

traumatic disruption of bone and periosteum causes | significant hemorrhage that initiates

fracture healing

3-main phases of fracture healing:

1) Inflammatory (48-hours) 2) Repair (7-14-days) 3) Remodeling (9-24 months)

Requirements for fracture healing:

a) good fragments apposition and normal blood supply b) sufficient immobilisation with adequate physiological stress c) absence of infection d) absence of systemic factors

hematoma and inflammatory mediators within first 48-hours initiate chemotaxis with phagocytes and repair cells being drawn to fracture site (shortest phase)

Inflammatory phase

cells involved during initial inflammation will gradually begin to form granulation tissue and remove unwanted material and damaged cell.

Repair phase

During this phase within 7-14 days hematoma becomes vascularised and may appear more translucent on x-rays.

Repair phase

Damaged tissue will gradually become populated by fibroblasts and chondrocytes and bone remodeling will begin

Repair phase

Fracture callus still remains very vulnerable to shearing forces but may be better stimulate if limited axial forces are applied.

Repair phase

when population of cells will sufficiently evolve into fibroblasts, chondrocytes and osteoblasts the osteoid and bone mineralisation will continue.

Remodeling phase

Remodeling phase on average may take

9-24 | months

pediatric fractures heal quicker due to _______ of the periosteum.

vascularity

takes twice as long as physiologically expected

Delayed union

no healing for >9-months:

Non-union (pseudoarthrosis

2 types of Disturbed fracture healing

1. Delayed union | 2. Non-union

3 types of non-union

a. hypertrophic b. Hypotrophic c. atrophic

- abnormal exuberant callus

hypertrophic non-union

week callus with insufficient vascularisation and new bone | formation

Hypotrophic non-union

absent callus often with synovial fluid or infected exudate | intervening between fracture ends

atrophic non-union

healing occurred in abnormally positioned fracture ends

Malunion

- neurological and vascular injury - acute compartment syndrome and renal failure - pulmonary fat embolism - gas gangrene

IMMEDIATE complications of fracture

- osteomyelitis - sepsis - complex regional pain syndrome formerly known as RSDS - non-union/malunion

INTERMEDIATE complications of fracture

- ischemic necrosis (AVN) | - secondary osteoarthritis

LATE complications of fracture

What type of fracture may sometimes cause | lead toxicity

Gun shot wound (GSW) | if bullet was lodged in peritoneal cavity

Skeletal Trauma Flashcards

(85 cards)